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Le Loarer F, Watson S, Pierron G, de Montpreville VT, Ballet S, Firmin N, Auguste A, Pissaloux D, Boyault S, Paindavoine S, Dechelotte PJ, Besse B, Vignaud JM, Brevet M, Fadel E, Richer W, Treilleux I, Masliah-Planchon J, Devouassoux-Shisheboran M, Zalcman G, Allory Y, Bourdeaut F, Thivolet-Bejui F, Ranchere-Vince D, Girard N, Lantuejoul S, Galateau-Sallé F, Coindre JM, Leary A, Delattre O, Blay JY, Tirode F. SMARCA4 inactivation defines a group of undifferentiated thoracic malignancies transcriptionally related to BAF-deficient sarcomas. Nat Genet 2015; 47:1200-5. [PMID: 26343384 DOI: 10.1038/ng.3399] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/17/2015] [Indexed: 01/09/2023]
Abstract
While investigating cohorts of unclassified sarcomas by RNA sequencing, we identified 19 cases with inactivation of SMARCA4, which encodes an ATPase subunit of BAF chromatin-remodeling complexes. Clinically, the cases were all strikingly similar, presenting as compressive mediastino-pulmonary masses in 30- to 35-year-old adults with a median survival time of 7 months. To help define the nosological relationships of these tumors, we compared their transcriptomic profiles with those of SMARCA4-mutated small-cell carcinomas of the ovary, hypercalcemic type (SCCOHTs), SMARCB1-inactivated malignant rhabdoid tumors (MRTs) and lung carcinomas (of which 10% display SMARCA4 mutations). Gene profiling analyses demonstrated that these tumors were distinct from lung carcinomas but related to MRTs and SCCOHTs. Transcriptome analyses, further validated by immunohistochemistry, highlighted strong expression of SOX2, a marker that supports the differential diagnosis of these tumors from SMARCA4-deficient lung carcinomas. The prospective recruitment of cases confirmed this new category of 'SMARCA4-deficient thoracic sarcomas' as readily recognizable in clinical practice, providing opportunities to tailor their therapeutic management.
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Perrier L, Kembou NS, Rascle P, Bui B, Morelle M, Ranchère VD, Terrier P, Neuville A, Decouvelaere AV, Le Cesne A, Gomez F, de la Fouchardière C, Meeus P, Trédan O, Pérol M, Fayette J, Neidhardt EM, Biron P, Boyle HJ, Marec BP, Farsi F, Ducimetière F, Blay JY, Ray CI, Coindre JM. Economic Impact of Centralized Histological Reviews in Patients with Sarcoma, Gist, and Desmoid Tumors. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A624. [PMID: 27202203 DOI: 10.1016/j.jval.2014.08.2219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Dantas-Barbosa C, Loarer FL, Mendiola M, Treilleux I, Chibon F, Sayadi HE, Coindre JM, Alberti L, Blay JY. Abstract 2780: Tyro3 and Axl receptors tyrosine kinase as potential therapeutic targets in leiomyosarcoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Leiomyosarcoma (LMS) represents 15% of adult sarcomas. Once metastatic, curative options are limited and innovative strategies are needed. TYRO3 and AXL proto-oncogenes belong to TAM family (Tyro3/Axl/Mer) of tyrosine kinase receptors, with oncogenic properties that are often overexpressed or activated in various malignancies. Using kinexus phosphoprotein microarrays (KAM-1.1) and western blot analyses, we evidenced that Tyro3 and Axl are overexpressed in LMS along with Gas6, their ligand. Interestingly LMS samples harbouring high levels of Gas6 and its receptors also presented AKT phosphorylation on S473 residue keeping with previous studies that highlighted AKT- mTOR activation in leiomyosarcomas. Based on these premises, we asked whether Tyro3-Axl axis may drive LMS proliferation and could represent potential targets in these tumors. The overexpression of Tyro3 was found to be associated with a specific miRNA signature, notably with an overexpression of miR22 in LMS tumors. Furthermore Tyro3 and Axl were found overexpressed in a panel of 6 LMS cell lines (SK-LMS-1 from ATCC and IB112, IB118, IB133, IB134 and IB136 from Institut Bergonié), compared with normal human smooth muscle. Tyro3 or Axl knockdown via shRNA retroviral vector reduced cell proliferation by up to 50 and 64% respectively and decreased soft agar colony-forming ability. Crizotinib and foretinib are two tyrosine kinase inhibitors (TKI) targeting Met and Axl. Treatment of LMS cell lines with both TKIs resulted in a significant increase in cell death, with IC50 values ranging from 3.6 to 14.6µM and 0.7 to 1.8µM, respectively. Annexin V and PI staining revealed that cell death was mainly due to apoptosis. Flow cytometric cell cycle analysis demonstrates that both TKIs altered cell cycle phase distribution. A sub-G1 phase accumulation was observed for one of the cell lines; meanwhile the other cell lines presented a G2 arrest and 4n chromosomes accumulation accompanied by an increase in cell and nucleus sizes. Only foretinib induced nuclear fragmentation consistent with late apoptosis. Pharmacological inhibition also reduced migration and colony formation in soft agar. Drug combinations with an AKT inhibitor led to significant increase in growth inhibition in all tested cell lines. Crizotinib and foretinib reduced activation of Tyro3 or Axl-mediated downstream signaling including MAPK/ERK, PI3K/AKT along with an inhibition of Axl phosphorylation in a dose dependent manner. By immunoprecipitation we observed also a reduction in Tyro3 phosphorylation, following exposure to both agents, showing that Tyro3 is a new target for those drugs. IHC analysis of Tyro3, Axl and Gas6 expression in a cohort of LMS patient is ongoing. In vivo analysis wil be performed. In conclusion these results strongly suggest that Tyro3 and Axl are relevant therapeutic targets for LMS treatment and will be investigated in a proof of concept clinical trial.
Citation Format: Carmela Dantas-Barbosa, François Le Loarer, Marta Mendiola, Isabelle Treilleux, Frederic Chibon, Hyba El Sayadi, Jean Michel Coindre, Laurent Alberti, Jean-Yves Blay. Tyro3 and Axl receptors tyrosine kinase as potential therapeutic targets in leiomyosarcoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2780. doi:10.1158/1538-7445.AM2014-2780
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Chakiba C, Lagarde P, Pissaloux D, Neuville A, Brulard C, Pérot G, Coindre JM, Terrier P, Ranchere-Vince D, Ferrari A, Collini P, Suurmeijer AJH, Blay JY, Terrisse SA, Piperno-Neumann S, Averous G, Bui B, Orbach D, Italiano A, Chibon F. Response to chemotherapy is not related to chromosome instability in synovial sarcoma. Ann Oncol 2014; 25:2267-2271. [PMID: 25070544 DOI: 10.1093/annonc/mdu362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Synovial sarcoma (SS) is an aggressive soft-tissue tumor. Despite being considered as a chemosensitive disease, the real impact of perioperative chemotherapy on metastasis-free survival (MFS) is controversial. We have shown that metastatic relapse of SS is strongly associated with genomic complexity. There are no data regarding the potential correlation between genomic complexity and response to chemotherapy. PATIENTS AND METHODS The study population included 65 SS patients diagnosed between 1991 and 2013 and with available tissue material. Genomic profiling was carried out by using array-CGH. Forty-five SS out of the 65 patients were treated with neoadjuvant anthracycline/ifosfamide-based chemotherapy. Radiological response was assessed according to RECIST criteria. Histological response was defined by the percentage of recognizable tumor cells on the surgical specimen. RESULTS Genomic complexity was significantly associated with MFS. However, there was no statistically significant association between radiological or histological response and genomic complexity. CONCLUSION The absence of significant association between response to chemotherapy and genomic complexity suggests that the prognostic value of chromosome instability in SS is independent of response to chemotherapy; mechanisms leading to metastatic relapse of SS are intrinsic to the biology of the tumor and current cytotoxic drugs are only poorly efficient to prevent it.
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Mathoulin-Pélissier S, Chevreau C, Bellera C, Bauvin E, Savès M, Grosclaude P, Albert S, Goddard J, Le Guellec S, Delannes M, Bui BN, Mendiboure J, Stoeckle E, Coindre JM, Kantor G, Kind M, Cowppli-Bony A, Hoppe S, Italiano A. Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study. Ann Oncol 2013; 25:225-31. [PMID: 24285018 DOI: 10.1093/annonc/mdt407] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Soft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence. PATIENTS AND METHODS STS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported. RESULTS Two hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants. CONCLUSIONS Initial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary.
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Ray-Coquard I, Montesco MC, Coindre JM, Dei Tos AP, Lurkin A, Ranchère-Vince D, Vecchiato A, Decouvelaere AV, Mathoulin-Pélissier S, Albert S, Cousin P, Cellier D, Toffolatti L, Rossi CR, Blay JY. Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions. Ann Oncol 2012; 23:2442-2449. [PMID: 22331640 PMCID: PMC3425368 DOI: 10.1093/annonc/mdr610] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. METHODS Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. RESULTS Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). CONCLUSION More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
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Bui-Nguyen B, Ray-Coquard I, Chevreau C, Penel N, Bay JO, Coindre JM, Cupissol D, Italiano A, Bonichon F, Lotz JP, Thyss A, Jimenez M, Mathoulin-Pélissier S, Blay JY. High-dose chemotherapy consolidation for chemosensitive advanced soft tissue sarcoma patients: an open-label, randomized controlled trial. Ann Oncol 2012; 23:777-784. [PMID: 21652583 DOI: 10.1093/annonc/mdr282] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Metastatic soft tissue sarcoma (STS) prognosis remains poor and few cytotoxic agents offer proven efficacy. This randomized open phase III study examines whether high-dose (HD) chemotherapy with peripheral blood stem cells (PBSCs) could improve overall survival (OS) of chemosensitive patients. PATIENTS AND METHODS Advanced STS patients aged 18-65 years received four courses of standard mesna, adryamycin, ifosfamide and dacarbazine (MAID) treatment. Chemotherapy-responding patients and patients with at least stable disease amenable to complete surgical resection were randomized to receive standard dose (SD) with two successive MAID cycles or HD treatments of one MAID then MICE intensification: mesna (3.6 g/m(2), day 1-5), ifosfamide (2.5 g/m(2), day 1-4), carboplatin [area under the curve (AUC) 5/day 2-4] and etoposide (300 mg/m(2), day 1-4) with PBSC reinjection at day 7. RESULTS From 2000 to 2008, 207 patients received four cycles of MAID and 87 assessable patients were randomly assigned to receive the following: 46 SD, 41 HD, with 45 and 38 maintained for analyses after secondary centralized histological review. Futility analyses led to study closure in November 2008. Three-year OS was 49.4% for the SD group versus 32.7% for HD arm, hazard ratio= 1.26, 95% confidence interval 0.70-2.29; progression-free survival was 32.4% and 14.0%, respectively. HD treatment led to higher grades 3-4 toxicity. CONCLUSION This study failed to show an OS advantage for advanced STS patients treated with dose-intensified chemotherapy with PBSC.
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Jarry J, Belleannee G, Laurent C, Coindre JM, Evrard S. Primary malignant fibrous histiocytoma of the pancreas: benefit of the multidisciplinary approach. Eur J Gastroenterol Hepatol 2010; 22:765-8. [PMID: 20446353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Primary malignant fibrous histiocytoma (MFH) is an exceedingly rare tumour of the pancreas with a high recurrence rate and a poor prognosis. Only 11 cases have been reported in the past in the English literature. In this report, the authors present the case of a 45-year-old man who was first operated on for a primary MFH of the pancreas. Eleven months after the surgery, he was diagnosed with a tumoural recurrence presenting as hepatic and pulmonary metastasis. The patient underwent a multidisciplinary treatment of chemotherapy, percutaneous radiofrequency ablation, and a right hepatectomy combined with intraoperative radiofrequency ablation. Under multidisciplinary treatment, the patient fully recovered. He remains disease-free 3 years after his first surgery and 25 months after the recurrence. We report a case of a primary MFH of the pancreas treated by using a multidisciplinary approach resulting in an above average survival rate. Although further cases and longer follow-up periods are necessary to conclude about the role of multidisciplinary treatment in the long-term prognosis of primary MFH of the pancreas, we believe that multidisciplinary treatment could improve the survival rates of other patients.
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Blay JY, de The H, Italiano A, Bui B, Ranchere D, Perrier P, Cesne AL, Leroux A, Collin F, Coindre JM. Abstract 1780: p53 mutation predicts limited benefit from adjuvant chemotherapy in patients with localized completely resected high grade soft tissue sarcoma: a retrospective study on 117 patients of the French Sarcoma Group. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-1780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Rationale
TP 53 is frequently mutated in some sarcoma subtypes and its mutation status has been reported to be correlated to survival in some studies. We investigated whether TP53 status may play a role in determining outcome following resection of the primary tumor.
Material and methods
The functional status of p53 was tested in a retrospective series of 117 patients of the French Sarcoma Group with localized grade 2or 3 STS treated with surgery, followed by radiotherapy (70) and/or chemotherapy (37%) in whom frozen pre-treatment material was available. FASAY (Functional Analysis of Separated Alleles in Yeast) was used to test the functional properties of p53. Statistical analysis were performed using SPSS 16.0.
Results
The diagnosis and primary surgery was performed between April 1990 and March 2006. Median follow up was 10,5 years. There were 62% males 38% females, aged 16 to 92 (median 64) with 74% primary locations of the limbs, 26 trunk or H&N respectively. Major histotypes were MFH/undifferentiated (32%) leiomyosarcomas (LMS, 27%), liposarcomas (LPS, 16%), while grade 2 and 3 represented 27% and 73% respectively Functional inactivation of p53 was observed in 31 tumors (29%), and was not correlated to age, gender, site, histotype, with the exception of dedifferentiated LPS which never expressed a no functional p53 (0/12 vs 31/100, p=0.01). Mutations were more frequently observed in grade 3 vs grade 2 (33% vs 13%, p=0.03). 70% patients received adjuvant radiotherapy, and 17% received adjuvant chemotherapy (AdjCT). Adjuvant RT was not correlated to RFS and OS. Adjuvant CT was associated with a better RFS (trend p=0.07) and a better OS (p=0.008). P53 mutation was correlated marginally to a worse OS (p=0.03), and a worse RFS (p=0.03) in univariate analysis. Similar results were obtained when the DDLPS subgroup of patients- with mdm2 amplification, was removed from the group (p=0.01 and 0.006 for RFS and OS). Using Cox model with gender, age, size, LPS histology, depth, R, grade, trunk sites, p53, adjCT), only the last three were independently correlated to OS, while size, p53, and adjCT were retained by the model for RFS. In the WT p53 group, adjCT improved RFS (trend p=0,07) and OS (p=0,007). RT improved significantly RFS (p=0.001) and marginally OS (0.06). In Cox model in the WT group, tumor size, adjCT for RFS, and gender, DDLPS and adjCT for OS were the only independent factors Conversely, in the MUT p53 group, OS and RFS were super-imposable with adjuvant CT and adjuvant RT trending towards a worse outcome in the CT+ and RT+ subgroups.
Conclusion:
Mutations of p53 using Fasay correlated to RFS and OS and to a limited or no benefit of adjuvant CT for RFS and OS. A prospective series is required to confirm this observation which may be helpful for patient selection in the future.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1780.
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Giacchero D, Maire G, Nuin PA, Berthier F, Ebran N, Carlotti A, Celerier P, Coindre JM, Esteve E, Fraitag S, Guillot B, Ranchere-Vince D, Saiag P, Terrier P, Lacour JP, Pedeutour F. No Correlation between the Molecular Subtype of COL1A1–PDGFB Fusion Gene and the Clinico-Histopathological Features of Dermatofibrosarcoma Protuberans. J Invest Dermatol 2010; 130:904-7. [DOI: 10.1038/jid.2009.338] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol 2010; 72:6-15. [PMID: 19835758 DOI: 10.1016/j.ejrad.2009.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 02/07/2023]
Abstract
Imaging and histology are two complementary morphological techniques which play a fundamental role in the diagnosis and management of soft tissue sarcomas. Imaging allows to identify some pseudosarcomatous benign lesions such as myositis ossificans, intramuscular hemangioma, angiomyolipoma, intramuscular lipoma, giant cell tumour of tendon sheath, desmoid tumour and elastofibroma. There is no formal criterion for diagnosing a sarcoma on magnetic resonance imaging (MRI) but malignancy is strongly suspected with the presence of necrosis and vascular, bone or joint invasion. Imaging may also suggest some histological types of sarcoma such as well-differentiated liposarcoma, dedifferentiated liposarcoma, synovial sarcoma or extraskeletal osteosarcoma. Imaging is also extremely helpful in determining the appropriate kind of sampling to carry out and in guiding the performance of a microbiopsy. The appearance observed on imaging should always be taken into consideration for the interpretation of the microbiopsy by the pathologist.
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Stoeckle E, Coindre JM, Longy M, Binh MBN, Kantor G, Kind M, de Lara CT, Avril A, Bonichon F, Bui BN. A critical analysis of treatment strategies in desmoid tumours: a review of a series of 106 cases. Eur J Surg Oncol 2008; 35:129-34. [PMID: 18760561 DOI: 10.1016/j.ejso.2008.06.1495] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 06/19/2008] [Accepted: 06/17/2008] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The management of desmoid tumours, previously based on strategies employed for sarcomas, should be reassessed, given the morbidity of interventions used in their treatment. METHODS Long-term follow-up (median 123 months) of a series of 106 treated patients with 69 primary and 37 recurrent desmoids, in order to study natural history and outcome. RESULTS Desmoids typically evolved actively over a median period of 3 years, and stabilised thereafter. Recurrences or progression most commonly occurred between 14 and 17 months. Risk factors for recurrence were presentation (primary vs. recurrent), gender, tumour location and resection margins. However, survival was independent from these factors, with equivalent survival whether resection had been performed or not. Tumour control and functional outcome depended on location and presentation. Functional impairment was proportional to number of operations and whether patients had received radiotherapy. Recurrences were observed in 12/23 patients after radiotherapy. CONCLUSION Desmoids are relatively indolent tumours needing different approaches than sarcomas. Direct surgery is advisable only in primary lower trunk wall/girdle locations. Wait-and-see and medical treatment is preferable in other types of presentations.
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de Saint Aubain Somerhausen N, Coindre JM, Debiec-Rychter M, Delplace J, Sciot R. Lipoblastoma in adolescents and young adults: report of six cases with FISH analysis. Histopathology 2008; 52:294-8. [DOI: 10.1111/j.1365-2559.2007.02954.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fayette J, Martin E, Piperno-Neumann S, Le Cesne A, Robert C, Bonvalot S, Ranchère D, Pouillart P, Coindre JM, Blay JY. Angiosarcomas, a heterogeneous group of sarcomas with specific behavior depending on primary site: a retrospective study of 161 cases. Ann Oncol 2007; 18:2030-6. [PMID: 17974557 DOI: 10.1093/annonc/mdm381] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Angiosarcomas are rare, heterogeneous and a retrospective study was conducted to describe their natural history. PATIENTS AND METHODS We reviewed 161 files of angiosarcoma treated in three institutions of the French Sarcoma Group from 1980 to 2004. Survival and prognostic factors for survival were analyzed. RESULTS Median age was 52 years. Primary sites were the breast (35%), skin (20%) and soft tissues (13%). At initial diagnosis, 31 (19%) had metastases. Surgery was the first treatment in 121 (75%) patients combined with chemotherapy or radiotherapy in 34 and 32, respectively. Ninety (74%) of these 121 patients relapsed, mostly locally (50). With an average time since initial diagnosis of 8.1 years, 123 (76%) patients progressed and 76 (47%) died. Median survival was 3.4 years [95% confidence interval (CI) 2.4-5.8], and the 5-year overall survival (OS) rate was 43% (95% CI 33-53). In multivariate analysis, liver primary site [relative risk (RR) = 12.62], performance status (PS) of two or more (RR = 3.83), presence of metastases at diagnosis (RR = 2.50), soft tissue tumor (RR = 0.31) were correlated to OS. PS, liver and soft tissue tumors were identified as independent prognostic factors for progression-free survival. CONCLUSIONS Angiosarcomas have an overall poor outcome, but with a clearly distinct prognosis depending on the primary site.
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Henriques de Figueiredo B, Kantor G, Bui Nguyen Binh M, Duparc A, Guerder C, Stoeckle E, Coindre JM, Bui BN. [Epithelioid sarcoma: a retrospective study of conservative treatment with initial surgery and radiotherapy]. Cancer Radiother 2007; 11:227-33. [PMID: 17652004 DOI: 10.1016/j.canrad.2007.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 06/12/2007] [Accepted: 06/28/2007] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epithelioid sarcoma is a rare type of soft tissue sarcomas with a high risk of recurrence both local and distant. The place of surgical conservative treatment and the role of radiation therapy remain controversial. PATIENTS AND METHODS A serie of 9 consecutive patients treated with initial conservative surgery and postoperative radiotherapy (median dose of 52.8 Gy) from 1987 to 2006 in the same institution was analyzed. RESULTS With a median follow-up of 40 months (range 15-153 months), the rate of local, nodal and distant relapse is respectively 56%, 11% and 33%. The rate of death is 44.5%. No imputation has been performed. CONCLUSION Even with a high rate of local relapse observed, a conservative treatment doesn't seem to influence badly the overall survival (55.5% alive at 40 months). Indeed the rate of distant relapse and death are comparable with those found in the literature. Moreover relapse occurred almost within the irradiated volumes. An improvement of dose could be also discussed.
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Le Cesne A, Landi B, Bonvalot S, Monges G, Ray-Coquard I, Duffaud F, Bui Nguyen B, Bugat R, Chayvialle JA, Rougier P, Bouché O, Bonichon F, Lassau N, Vanel D, Nordlinger B, Stoeckle E, Meeus P, Coindre JM, Scoazec JY, Emile JF, Ranchère D, Blay JY. [Recommendations for the management of gastro-intestinal stromal tumors]. Ann Pathol 2007; 26:231-4. [PMID: 17127860 DOI: 10.1016/s0242-6498(06)70713-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Coindre JM, Ranchère D, Collin F. [How to classify a soft tissue sarcoma in 2006]. Ann Pathol 2006; 26 Spec No 1:1S98-109. [PMID: 17149200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Dimet S, Lazure T, Palazzo L, Coindre JM, Fabre M. Fine needle aspiration of a mediastinal spindle cell tumour: cytological, immunocytochemical and molecular diagnosis. Cytopathology 2006; 17:97-9. [PMID: 16548995 DOI: 10.1111/j.1365-2303.2006.00321.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Collin F, Gelly-Marty M, Bui Nguyen Binh M, Coindre JM. Sarcomes des tissus mous : données anatomopathologiques actuelles. Cancer Radiother 2006; 10:7-14. [PMID: 16310396 DOI: 10.1016/j.canrad.2005.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2005] [Indexed: 11/21/2022]
Abstract
Over the last fifteen years, pathology underwent significant changes in the field of soft tissue tumours. They were related to considerable advances in molecular biology and genetics. New data led to the revision of the WHO classification. Malignant fibrous histiocytoma is no longer considered as an entity. It has split up into several subgroups belonging to liposarcomas, leiomyosarcomas or undifferentiated sarcomas. Haemangiopericytoma underwent reappraisal and was put in the same category as solitary fibrous tumour. Many tools have improved. Immunohistochemistry performed with new antibodies had its specificity increased, and became appropriate for the prediction of therapeutic response in some cases, e.g. CD117 detecting mutations of the c-kit proto-oncogen in gastro-intestinal stromal tumours. Refinement of the techniques allows accurate diagnoses from core needle biopsies. Surgical specimens are collegially examined by surgeons and pathologists with special attention paid to resection margins. Although bound by some limitations, the grading system of the French Federation of Cancer Centers has currently remained the best predictor of metastasis-free survival and overall survival of patients. It is based on an assessment of three parameters: differentiation, amount of necrosis, and mitotic count of tumours. The pathologist sets up a diagnosis, and actively takes part in the prediction of the prognosis and therapeutic response. He is one of the major participants in decision making for multimodal treatment of sarcomas.
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Binh MBN, Sastre-Garau X, Guillou L, de Pinieux G, Terrier P, Lagacé R, Aurias A, Hostein I, Coindre JM. MDM2 and CDK4 Immunostainings Are Useful Adjuncts in Diagnosing Well-Differentiated and Dedifferentiated Liposarcoma Subtypes. Am J Surg Pathol 2005; 29:1340-7. [PMID: 16160477 DOI: 10.1097/01.pas.0000170343.09562.39] [Citation(s) in RCA: 394] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atypical lipomatous tumor/well-differentiated liposarcoma (ALT-WDLPS) and dedifferentiated liposarcoma (DDLPS) may be difficult to distinguish from benign adipose tumors and from poorly differentiated sarcomas, respectively. Genetically, they are characterized by amplification of MDM2 and CDK4 genes on chromosome 12q13-15. We examined a series of 559 soft tissue tumors (44 ALT-WDLPS, 61 DDLPS, 49 benign adipose tumors, and 405 non-ALT-WDLPS/DDLPS sarcomas) for MDM2 and CDK4 expression using immunohistochemistry. MDM2 and CDK4 immunoexpressions were compared with gene amplification status (as assessed by quantitative PCR and/or comparative genomic hybridization) in 241 neoplasms. Most ALT-WDLPS/DDLPS expressed MDM2 (97%) and CDK4 (92%) as opposed to few benign adipose tumors (MDM2, 5%; CDK4, 2%) and a limited number of non-ALT-WDLSP/DDLPS sarcomas (MDM2, 19%; CDK4, 6%). The sensitivity and specificity of MDM2 and CDK4 immunostainings in identifying ALT-WDLPS/DDLPS among other soft tissue tumors were 97% and 92%, and 83% and 95%, respectively. MDM2 and CDK4 immunostainings were particularly useful to separate ALT-WDLPS from the large group of differentiated adipose tumors, and to distinguish DDLPS from poorly differentiated sarcomas. A strong correlation was observed between MDM2 and CDK4 stainings and gene amplification status. In conclusion, MDM2 and CDK4 immunostainings, which correlate with gene amplification, are helpful adjuncts to differentiate ALT-WDLPS from benign adipose tumors and to separate DDLPS from poorly differentiated sarcomas.
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Côté JF, de Saint-Maur PP, Coindre JM, Bruneval P, Badoual C. Unusual strong CD34 positivity in a thoracic monophasic fibrous synovial sarcoma. Histopathology 2005; 45:539-40. [PMID: 15500659 DOI: 10.1111/j.1365-2559.2004.01917.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hostein I, Pelmus M, Aurias A, Pedeutour F, Mathoulin-Pélissier S, Coindre JM. Evaluation ofMDM2 andCDK4 amplification by real-time PCR on paraffin wax-embedded material: a potential tool for the diagnosis of atypical lipomatous tumours/well-differentiated liposarcomas. J Pathol 2003; 202:95-102. [PMID: 14694526 DOI: 10.1002/path.1495] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Atypical lipomatous tumours/well-differentiated liposarcomas and dedifferentiated liposarcomas are characterized by 12q13-15 region amplification. In contrast, this molecular event has not been reported in benign lipomas. Within the 12q13-15 chromosomal region, the MDM2, SAS, HMGA2, and CDK4 genes are the most frequent targets of amplification. A series of lipomas (36 cases) and liposarcomas (48 cases) was analysed for MDM2 and CDK4 gene amplification by real-time PCR. MDM2 and CDK4 gene amplification was detected in 2.8% and 5.6% of lipomas and 98.2% and 82.4% of liposarcomas, respectively. Moreover, co-amplification of the two genes as well as a higher-level amplification was observed more frequently in dedifferentiated liposarcomas than in atypical lipomatous tumours/well-differentiated liposarcomas. Real-time PCR proved to be a fast and reliable method to characterize lipomas and liposarcomas by quantification of MDM2 and CDK4 gene amplification. It is applicable to paraffin wax-embedded tissues and could be useful when histological diagnosis is difficult.
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Macgrogan G, de Mascarel I, Soubeyran I, Henriquès C, Barreau B, Dilhuydy MH, Tunon de Lara C, Bussières E, Coindre JM. [Diagnostic approach to breast papillary lesions]. Ann Pathol 2003; 23:601-10. [PMID: 15094599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Breast papillary lesions are difficult to interpret and include a large variety of benign, atypical and malignant lesions. We report the case of a 41-Year-old woman presenting with an intracystic papillary carcinoma, in order to illustrate our pragmatic diagnostic approach, which includes the use of a decision tree, useful for differentiating the different types of breast papillary lesions.
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MESH Headings
- Adult
- Algorithms
- Breast Neoplasms/complications
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Papillary/complications
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Female
- Fibrocystic Breast Disease/complications
- Fibrocystic Breast Disease/diagnostic imaging
- Fibrosis
- Humans
- Inflammation
- Metaplasia
- Myoepithelioma/diagnosis
- Myoepithelioma/pathology
- Neovascularization, Pathologic/pathology
- Papilloma/classification
- Papilloma/diagnosis
- Papilloma/pathology
- Prognosis
- Ultrasonography
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Coindre JM, Blanc-Vincent MP, Collin F, Mac Grogan G, Balaton A, Voigt JJ. [2001 Standards, Options and Recommendations: practice guidelines for difficult diagnoses in surgical pathology or cytopathology in cancer patients]. Ann Pathol 2003; 23:460-70. [PMID: 14752395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
CONTEXT The Standards, Options and Recommendations (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES To elaborate practice guidelines for difficult diagnoses in surgical pathology or cytopathology in cancer patients. METHODS The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS The main recommendations to prevent and reduce the number of difficult diagnoses in surgical pathology or cytopathology are: The main recommendations to detect lesions associated with difficult diagnosis in surgical pathology or cytopathology are: The main recommendations to solve difficult diagnosis in surgical pathology or cytopathology are:
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MacGrogan G, Rudolph P, Mascarel Id ID, Mauriac L, Durand M, Avril A, Dilhuydy JM, Robert J, Mathoulin-Pélissier S, Picot V, Floquet A, Sierankowski G, Coindre JM. DNA topoisomerase IIalpha expression and the response toprimary chemotherapy in breast cancer. Br J Cancer 2003; 89:666-71. [PMID: 12915875 PMCID: PMC2376904 DOI: 10.1038/sj.bjc.6601185] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The alpha isoform of Topoisomerase IIalpha (Topo IIalpha) is a proliferation marker as well as a target for several chemotherapeutic agents such as anthracyclines. In vitro studies have demonstrated the relationship between the Topo IIalpha expression level and chemosensitivity of target cancer cells. To verify this effect in vivo, we selected 125 patients presenting with T(2)>3 cm and T(3) N(0-1) M(0) breast tumours who were treated by six cycles of primary chemotherapy, including epirubicin before any surgery. Therapy response was assessed by clinical and X-ray mammogram measurements of tumour shrinkage. The pretherapeutic core biopsies were immunostained with a monoclonal antibody (Ki-S7) against Topo IIalpha. Ki-S7 positivity ranged from 0 to 50% (median, 15%). A high percentage of Ki-S7-positive cells (>15%) was associated with tumour regression under chemotherapy (OR=2.88, CI: 1.3-6.4, P=0.004). Ki-S7 further emerged as an independent predictor of tumour regression (OR=3.34, CI: 1.41-7.93, P=0.006), together with tumour size of less than 40 mm (OR=3.82, CI: 1.58-9.25, P=0.002) and negative oestrogen receptor (ER) status (OR=3.35, CI: 1.43-7.86, P=0.005), in a multivariate analysis including tumour size, SBR grade, ER and PR status, Ki-67, p53 and Her-2/neu. Our clinical results confirm in vitro data on the relationship between Topo IIalpha expression and tumour chemosensitivity and thus may have important practical implications.
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